NCIC Form 19 Workers' Compensation Information

The Workers' Compensation Program for East Carolina University is administered by the Office of Environmental Health and Safety. Workers' Compensation benefits are available to any full-time, part-time, or temporary employee, including student workers, that suffer an accidental injury or contracts an occupational disease within the definitions of the Worker's Compensation Act. Workers' Compensation cases which exceed certain monetary or time limits are transferred to CorVel, the NC third party administrator.

If you are hurt on the job at ECU follow these procedures:

If there is a life-threatening emergency or serious injury, seek medical assistance immediately, then complete the steps below.

If the injury is not life-threatening, then complete the following steps first and a medical evaluation will be set up for you if required.

Report the injury or illness to your supervisor.

Report the injury or illness to ECU Environmental Health and Safety by calling 328-6166 and asking for the Workers' Compensation Manager.

If injury occurs after hours or on a weekend, contact ECU Police at 328-6787. They will notify ECU EH&S personnel.

Fill out the forms listed below. The forms can be downloaded as a editable pdf (save to computer first) or printed as a hard copy. You must hand write your signature on forms, electronic signatures are not permitted.

If you need assistance completing the forms, contact EH&S.

If a student is injured while conducting assignments or other general duties on campus (classroom, laboratory, etc) then the student should contact Student Health for medical attention or 911 if life-threatening injury. They should also complete the
Student Statement of Injury Form to ensure documentation of the incident.